You may request an appeal in any of the following ways:
Once we have processed your request, we will send you a notice. We will also post the notice in your NY State of Health account.
If you would like to keep your eligibility and coverage while the Appeals Unit decides your appeal ask for it when you call to request your appeal. If you are using the Appeal Request Form check the box in Section 4. We will send you a notice telling you if we approved your request.
Make your Request by Telephone
To request an appeal by telephone call us at 1-855-355-5777
Send a Printable Request Form
Complete a printable version of the Appeal Request Form and return it by mail, fax or by uploading it to your account.
You may upload the form to your NY State of Health account at www.nystateofhealth.ny.gov.
You may mail the form to the following address:
NY State of Health
P.O. Box 11729
Albany, NY 12211
You may also fax the form to 1-855-900-5557.
Any way you choose, your appeal request must
- Give your Marketplace Account ID and Date of the Notice you received from us stating the decision you want to appeal or your date of birth and social security number or other identifying information if you did not receive a notice from us. You can locate your Marketplace Account ID near the top of your Marketplace notice. It begins with “AC.”
- Be sent within 60 calendar days of the date of this Notice.
- Say why you think we should change this determination.
- Provide materials, online or by fax or mail, to back up your reason(s).
- Clearly state if you wish to fast-track your appeal process because of your medical condition. Make sure to include a note from your doctor backing up your reason(s) for needing to fast-track your Appeal.
From start to finish, a normal appeal process will take 90 days.
We will decide a fast-track appeal as soon as possible.